Provider Demographics
NPI:1790794956
Name:CARMONA, NESTOR MAKILAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:MAKILAN
Last Name:CARMONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9836 CLANFORD RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2508
Mailing Address - Country:US
Mailing Address - Phone:410-922-2094
Mailing Address - Fax:410-922-2094
Practice Address - Street 1:200 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3709
Practice Address - Country:US
Practice Address - Phone:410-951-5083
Practice Address - Fax:410-951-5082
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013649146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76175Medicare UPIN
MD2120Medicare ID - Type Unspecified